Rare good news for state mental health system

Since the state Supreme Court’s “psychiatric boarding” ruling last month, the news has been all bad for the state. The ruling requires Gov. Jay Inslee’s administration to find at least 145 new beds, or else patients who need involuntary psychiatric care could be cut loose, without treatment, to the streets.

The view from the King County Superior court room at Harborview Medical Center where involuntary commitment cases are heard. (Mike Seigal / Seattle Times)

That task is so big that the Department of Social and Health Services had to get an unusual 120-day stay on the court’s ruling. And it’s so expensive that Inslee authorized $30 million in un-budgeted mental health funding, just to get through 2014.

Last week, the state finally got some good news. DSHS got word that it obtained a waiver from what’s known as the “IMD exclusion,” an arcane 1960’s-era rule that bans Medicaid from paying for psychiatric hospitalizations in facilities larger than 16 beds.

Getting the waiver, in short, means that addressing the Supreme Court psychiatric boarding ruling will cost “significantly less” than expected, said Jane Beyer, DSHS’s mental health division director. Initial estimates of $100 million or more for the 2015-17 biennium will now be lower.

King County – where boarding is most common – benefits the most, because it has several psychiatric facilities – including Fairfax in Kirkland and Navos in West Seattle – that are excluded from getting Medicaid under the IMD exclusion.

In a letter sent to lawmakers last week, DSHS laid out the rest of its plan. New short-term “evaluation & treatment” facilities are authorized for King and Pierce counties, and for the mental health network from Snohomish County to the Canadian border. In addition, the state wrote new rules to encourage community hospitals that don’t currently have psychiatric units to add psychiatric beds. Discussions are in the works to reopen beds at Western State Hospital, provided enough trained staff – particularly psychiatrists – can be hired.

The challenge for lawmakers will be putting together a long-term plan that adds enough inpatient beds to end boarding while ensuring enough preventative care to reduce the need for hospitalization. The financial part of that job, for now, gets a bit easier.